NORTRIPTYLINE HCL 75 MG CAPSULE [Pamelor] (30 CAPSULES ) (NDC: 51672400401)
2024 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
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Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Additional Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
AARP Medicare Advantage from UHC VA-0004 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0004 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$14.00 | $0.00 | None | $8.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0008 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0008 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $0.00 | None | $8.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0013 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0013 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$350* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$14.00 | $0.00 | None | $9.29 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0016 (PPO)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0016 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$14.00 | $0.00 | None | $8.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Premier Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Premier Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $9.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Aetna Medicare Select Plan (HMO-POS)
![Email Prescription and/or Health Benefit details for Aetna Medicare Select Plan (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $9.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare SmartFit (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare SmartFit (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$250 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
50% | 50% | None | $10.72 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Chronic Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem Chronic Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$7.50 | $0.00 | None | $3.98 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Grocery (HMO)
![Email Prescription and/or Health Benefit details for Anthem Grocery (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | None | $4.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Grocery (PPO)
![Email Prescription and/or Health Benefit details for Anthem Grocery (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$13.00 | $0.00 | None | $4.05 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Kidney Care (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Anthem Kidney Care (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$325* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | None | $4.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Medicare Advantage (HMO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$10.00 | $0.00 | None | $3.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Medicare Advantage (PPO)
![Email Prescription and/or Health Benefit details for Anthem Medicare Advantage (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$95* |
Yes, but No Gap Coverage for this drug. |
2* |
Generic |
$13.00 | $0.00 | None | $4.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Choice H8145-004 (PFFS)
![Email Prescription and/or Health Benefit details for Humana Gold Choice H8145-004 (PFFS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$160 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $6.45 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.27 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$145 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H5619-157 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H5619-157 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Plus H6622-004 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-004 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $6.46 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-083 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-083 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $6.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-266 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-266 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-308 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-308 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $6.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-312 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-312 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$95.00 | $275.00 | None | $6.51 |
Browse Plan Formulary all covered insulin pay $35 or less |
LifeWorks Premier Care (HMO-POS I-SNP)
![Email Prescription and/or Health Benefit details for LifeWorks Premier Care (HMO-POS I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | n/a | None | $15.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Memory Care (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Memory Care (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $6.00 | None | $15.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Choice Care (HMO)
![Email Prescription and/or Health Benefit details for Molina Medicare Choice Care (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$125 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Generic |
$12.00 | $24.00 | None | $6.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Premier Care (HMO-POS I-SNP)
![Email Prescription and/or Health Benefit details for Premier Care (HMO-POS I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$0 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Preferred Generic |
$2.00 | $6.00 | None | $15.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Sentara Medicare Engage-Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | None | $10.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Medicare Savings (HMO)
![Email Prescription and/or Health Benefit details for Sentara Medicare Savings (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | None | $10.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Medicare Value (HMO)
![Email Prescription and/or Health Benefit details for Sentara Medicare Value (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | None | $10.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Sentara Medicare Value (HMO)
![Email Prescription and/or Health Benefit details for Sentara Medicare Value (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$0.00 |
$150* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$10.00 | $0.00 | None | $10.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Community Complete Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Sentara Community Complete Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$14.90 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $10.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Community Complete (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Sentara Community Complete (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$17.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $10.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Essential Plan (PPO)
![Email Prescription and/or Health Benefit details for Aetna Medicare Essential Plan (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.00 |
$300 |
Yes, but No Gap Coverage for this drug. |
3 |
Preferred Brand |
$47.00 | $141.00 | None | $10.52 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Together in Health (PPO I-SNP)
![Email Prescription and/or Health Benefit details for Humana Together in Health (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$18.30 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Tier 4 |
25% | 25% | None | $6.63 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus - Diabetes and Heart (HMO C-SNP)
![Email Prescription and/or Health Benefit details for Humana Gold Plus - Diabetes and Heart (HMO C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$21.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $6.55 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Extra Help (HMO)
![Email Prescription and/or Health Benefit details for Anthem Extra Help (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$25.10 |
$545 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$10.00 | $0.00 | None | $4.01 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Home Care (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Anthem Home Care (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$26.70 |
$0 |
Yes, this drug has Gap Coverage. |
2 |
Generic |
$7.50 | $0.00 | None | $20.20 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$29.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $3.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care Select (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care Select (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$30.70 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
15% | 15% | None | $6.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
AARP Medicare Advantage from UHC VA-0009 (HMO-POS)
![Email Prescription and/or Health Benefit details for AARP Medicare Advantage from UHC VA-0009 (HMO-POS)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$31.00 |
$0 |
Yes, but No Gap Coverage for this drug. |
2 |
Generic |
$8.00 | $0.00 | None | $8.92 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Value (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Value (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$33.60 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $5.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Nursing Home Plan EX-F004 (PPO I-SNP)
![Email Prescription and/or Health Benefit details for UHC Nursing Home Plan EX-F004 (PPO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$35.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
25% | 25% | None | $9.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Molina Medicare Complete Care (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Molina Medicare Complete Care (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$36.10 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
$0.00 | $0.00 | None | $6.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Better Health of Virginia (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Better Health of Virginia (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $5.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Aetna Medicare Assure Premier (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Aetna Medicare Assure Premier (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.40 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
3 |
Tier 3 |
$0.00 | $0.00 | None | $5.66 |
Browse Plan Formulary all covered insulin pay $35 or less |
Align Kidney Care (HMO-POS C-SNP)
![Email Prescription and/or Health Benefit details for Align Kidney Care (HMO-POS C-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545* |
No additional gap coverage, only the Donut Hole Discount |
1* |
Preferred Generic |
$2.00 | $6.00 | None | $15.91 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Dual Advantage (PPO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Dual Advantage (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $3.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Anthem Full Dual Advantage (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Full Dual Advantage (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $3.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage 2 (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Full Dual Advantage 2 (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $3.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Anthem Full Dual Advantage Support (HMO D-SNP)
![Email Prescription and/or Health Benefit details for Anthem Full Dual Advantage Support (HMO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $3.10 |
Browse Plan Formulary all covered insulin pay $35 or less |
Humana Gold Plus H6622-085 (HMO)
![Email Prescription and/or Health Benefit details for Humana Gold Plus H6622-085 (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.48 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice H5216-363 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-363 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
Yes, but No Gap Coverage for this drug. |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.56 |
Browse Plan Formulary all covered insulin pay $35 or less |
Senior Care (HMO I-SNP)
![Email Prescription and/or Health Benefit details for Senior Care (HMO I-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
1 |
Tier 1 |
25% | n/a | None | $15.60 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
UHC Dual Complete VA-Q001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-Q001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $9.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-S001 (PPO D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-S001 (PPO D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $9.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-S002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-S002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $9.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-V001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-V001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
15% | 15% | None | $9.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-Y001 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-Y001 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $9.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
UHC Dual Complete VA-Y002 (HMO-POS D-SNP)
![Email Prescription and/or Health Benefit details for UHC Dual Complete VA-Y002 (HMO-POS D-SNP)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$38.50 |
$545 |
No additional gap coverage, only the Donut Hole Discount |
2 |
Tier 2 |
$0.00 | $0.00 | None | $9.30 |
Browse Plan Formulary all covered insulin pay $35 or less |
Plan Name |
Monthly Prem. |
De- duct- ible |
Additional Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
HumanaChoice H5216-144 (PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice H5216-144 (PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$39.00 |
$265 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None | $6.36 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Medicare Prime (HMO)
![Email Prescription and/or Health Benefit details for Sentara Medicare Prime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.00 |
$130* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $0.00 | None | $10.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
Sentara Medicare Prime (HMO)
![Email Prescription and/or Health Benefit details for Sentara Medicare Prime (HMO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$63.00 |
$130* |
No additional gap coverage, only the Donut Hole Discount |
2* |
Generic |
$8.00 | $0.00 | None | $10.50 |
Browse Plan Formulary all covered insulin pay $35 or less |
HumanaChoice R1390-002 (Regional PPO)
![Email Prescription and/or Health Benefit details for HumanaChoice R1390-002 (Regional PPO)](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
$105.00 |
$480 |
No additional gap coverage, only the Donut Hole Discount |
4 |
Non-Preferred Drug |
$99.00 | $287.00 | None | $6.50 |
Browse Plan Formulary all covered insulin pay $35 or less |